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 Flaccid Dysarthria (无力型)  Vocal Fold Paralysis  Cricothyroid Muscle Paralysis  Bilateral Vocal Fold Paralysis  Unilateral Vocal Fold Paralysis 

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Presentation on theme: " Flaccid Dysarthria (无力型)  Vocal Fold Paralysis  Cricothyroid Muscle Paralysis  Bilateral Vocal Fold Paralysis  Unilateral Vocal Fold Paralysis "— Presentation transcript:

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2  Flaccid Dysarthria (无力型)  Vocal Fold Paralysis  Cricothyroid Muscle Paralysis  Bilateral Vocal Fold Paralysis  Unilateral Vocal Fold Paralysis  Hypokinetic Dysarthria (运动功能减退型)  Parkinson’s Disease

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4  Cause/etiology  Bilateral or unilateral damage to specific cranial nerves  At their nuclei in the brain stem  Somewhere along their extracranial route to the speech sub system muscles that they innervate

5  Symptoms (damage to peripheral nervous system)  Flaccid paralysis  Reduced force of muscle contraction (肌肉收缩力量减 小)  Reduced range of motion (运动范围减小)

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7  A kind of Flaccid Dysarthria patient  Cause/etiology  Damage to the cranial nerve Ⅹ  The type and extent of dysphonia depends on  The lesion site  Bilateral or unilateral  Partial or complete

8  Cause/etiology  Mostly viral infection of SLN  Bilateral or unilateral  Function of cricothyroid  Tensing of the VF  Elevation of picth  VF adduction

9  Sign  A slight rotation of the invovled VF  A slight bowing of the invovled VF  Typical voice symptoms  Inability to elevate or lower pitch  Some breathiness – bowing

10  Treatment  Medicine  Corticosteriods and antivirtal agents  Surgery  Selective reinnervation of the cricothyroid muscle  Thyroplasty

11  Cause/etiology  Lesions in the trunk of the vagus nerve  Lesions at the nuclei of origin in the medulla  Neonatal stridor 新生儿喉喘鸣( common reason in children )

12  Types and symptoms  Adductory - neither VF can move to midline  Making phonation impossible  At risk for aspiration (误吸)  Abductory - the VFs remain at the midline  Serious respiratory problems  tracheostomy

13  Treatment – for continued bilateral VF paralysis  Tracheostomy – greater airway competence  Surgical reinnervation of VFs  Unilateral removal of one arytenoid - more anterior glottal closure  Electrical stimulation to the posterior cricoarytenoid muscle  Laser surgery - decrease open glottal space for bilateral adductor fold paralysis

14  Cause/etiology  Damage to one side of RLN  Disease  Trauma - surgical trauma (most common reason)  Location  Left UVFP is more common  The routes of the left and the right RLN are different

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17  Mechanism Damage to one side of RLN Poor Larygeal adductor muscles ( 麻 痹不能调节自身的张力等因素 ) Paralyzed fold in paramedian positio n Neither fully abducted nor adducted ( 声门不能完全闭合或开放 )

18  Symptoms UVFP Neither fully a bducted nor a dducted Breathy Short phonati on time Poor Larygeal adductor mus cles Pitch breaksDiplophoniaHoarsness Excessive sup raglottal const riction

19  Treatments  Traumatic UVFP can have spontaneous recovery with the first 9-12 months postonset Behavioral voice therapy Permanent cor rective proced ures

20  Behavioral voice therapy  Half-swallow boom  Head positioning  Tuck-chin  Digital manipulation  Focus  Tongue protursion /i/  Yawn-sigh  Pitch shift up  Inhalation phonation

21  Permanent corrective procedures  Paralyzed VF injection  Teflon  Fat - reabsorbed  Facial tissue  Thyroplasty  Rectangular window  Micrometric screw (微动螺丝)  Reinnervating the paralyzed VF  Phrenic nerve ( 膈神经 )  Section of SLN and hypoglossus nerve

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24  Cause/etiology  Problem with the effect of neurotransmitter dopamine on the activities of the basal ganglia  Depletion (损耗过多)  Functional reduction (功能减退)  Symptoms  Rigidity, slow movement - bradykinesia  Limited range of motion  Resting tremor

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26 Parkinson’s Disease (PD)  98% hypokinetic dysarthrias are of the Parkinson’s type  Symptoms  Reduced loudness  Breathy voice  Monotony of picth  Intermittent rapid rushes of speech  Soft production of consonants

27  Treatments Task Quick conversational pattern Mechanism Rapid and accelerated move ment of the articulators Results Speech is unintelligible

28  Treatments Speak with int ent Louderslower Better voic e quality Better artic ulation

29  Treatments  LSVT (Lee Silverman Voice Treatment)  Increase VF adduction  Respiratory effort  PLVT (Pitch limiting Voice Treatment)  Increase respiratory support  Phonation at a low pitch  DAF (delayed auditory feedback)  Instrumental procedure

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